Landmark legislation of 1875 established an Alabama Department of Health, designated the Medical Association of State of Alabama as the State Board of Health, and declared MASA’s Board of Censors to be the State Committee of Public Health. The medical societies were given authority to name municipal and county health officers. Despite this authorization, no full-time county health department was organized for more than 40 years.
In the early 20th century, Jefferson County, Alabama, stood at a crossroads. Ravaged by typhoid, malaria, tuberculosis, and poor sanitation, Birmingham had earned the grim title of “the unhealthiest city in the South.” But from this crisis emerged a vision. In 1916, Dr. Carroll Fox of the U.S. Public Health Service conducted a pivotal study that called for the unification of city and county health efforts. His recommendations laid the foundation for the Jefferson County Department of Health, officially established in 1917.
The early decades were marked by foundational work. Under the leadership of Dr. J.D. Dowling, the department tackled epidemics, enforced sanitation laws, and began inspecting food and milk supplies. Despite limited resources, the department grew steadily, establishing health centers and launching public education campaigns. The Great Depression tested its resolve, but federal relief programs helped sustain vital services.
World War II brought new challenges and opportunities. With many staff serving in the military, turnover was high, but the department expanded its reach. Under Dr. George A. Denison, the department unified city and rural services, launched venereal disease clinics, and oversaw the construction of a new public health building. The post-war years saw a surge in public health innovation—fluoridation studies, tuberculosis control, and the establishment of a Bureau of Dental Hygiene.
As Jefferson County grew, so did its health needs. The department responded with expanded services, including maternal and child health, mental health programs, and environmental health initiatives. The 1970s brought a focus on air pollution control and the construction of new health centers in underserved areas under Dr. George Hardy’s leadership. The department also began addressing systemic inequities, advocating for better hospital access for Black physicians and patients.
The 1980s and 1990s ushered in a new era of leadership and modernization. Under Dr. Bill Roper and later Dr. Samuelson, the department embraced data-driven decision-making, launched home health programs, and strengthened partnerships with Cooper Green Hospital and UAB. The department also led efforts in air quality regulation, septic system oversight, and community-based mental health services.
With the dawn of the 21st century, JCDH continued to evolve under Dr. Michael Fleenor. Following the terrorist acts in New York City on September 11, 2001, JCDH began to reconsider the rapidly increasing financial commitment to direct primary patient care in light of greater expectations for public health responses to acts of terrorism. Also, the department implemented electronic medical records, expanded immunization programs, and responded to emerging threats like H1N1 influenza pandemic.
During the 2010s, Dr. Mark Wilson ensured that the department deepen its commitment to health equity, launching initiatives to address disparities in chronic disease, birth outcomes, and access to care. The COVID-19 pandemic tested every facet of public health. JCDH rose to the occasion—establishing testing and vaccination sites, coordinating emergency response, and guiding schools and businesses through reopening. The department also addressed rising rates of syphilis, mpox, and opioid overdose crises, all while maintaining its core services.
From a city once plagued by epidemics to a county recognized for its progressive public health programs, Jefferson County’s journey is a testament to the power of organized community effort. Through wars, economic downturns, and pandemics, the Jefferson County Department of Health has remained steadfast—innovating, adapting, and inspiring. As the department looks to the future, it carries forward a legacy built not just on survival, but on hope, equity, and the unwavering pursuit of a healthier tomorrow.